Pain evaluation in preterm infants using skin conductance algesimeter
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Abstract
1.1 Background: Pain asessment is a challenge in patients who are unable to communicate verbally, e.g. neonates. Consequently, they may receive less effective analgesic treatment. Visual, behavioural and physiological pain scales are used clinically but they are not always reliable, especially in premature infants. Some studies have been published on the reliability and efficacy of a Skin Conductance Algesimeter (SCA) in monitoring pain in infants. However, the data is limited by small sample size and lack of utility in specific situations such as in ventilated children and during potentially painful procedures.
1.2 Objective: To evaluate clinical usefulness of SCA as a reliable measure of pain intensity and stress response in preterm infants.
1.3 Methods: The study was conducted over a period of 3 years and parents of all infants admitted to the NNU were invited to participate in the study. The SCA was compared with simultaneous measurement of ‘Premature Infant Pain Profile’ (PIPP) and ‘Face, Legs, Activity, Cry and Consolability (FLACC) scores during invasive / painful procedures by 2 independent assessors. Assessments were recorded for 3 minutes before, during and after the procedure.
1.4 Results: 85 measurements were recorded. PIPP and FLACC scores started low, increased during the procedure and decreased afterwards. For all SCA measurements, there was an increase in score pre-pro and a decrease in score pro-post. However, the standard deviation for variations was wider for some measurements than for others. Paired t-test comparing Delta pre-pro with Delta pro-post for all measurements {PIPP, FLACC, Area (small) and Peaks/sec} individually showed statistically significant differences (P<0.05). For Area (small), there was no significant correlation between SCA raw data and PIPP/FLACC scores.
1.5 Discussion: SCA, PIPP and FLACC scores increased during the painful procedures but correlation was too imprecise to use the SCA clinically to predict or measure behavioural responses to noxious stimuli in neonates.
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